Procedure to Modifier Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
According to the American Medical Association (AMA) and the Centers for Medicare and Medicaid Services (CMS), a modifier provides the means to report or indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code. It may also provide more information about a service such as it was performed more than once, unusual events occurred, or it was performed by more than one physician and/or in more than one location.
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Click to Download: Procedure to Modifier Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Q: Why aren’t all CPT and HCPCS modifiers addressed in this policy?
A: The intent of the Procedure to Modifier Policy is to validate appropriate modifier usage and is not meant to address all possible modifier situations. Modifiers not addressed by this policy may have:
a) no third-party industry standard source, policies or guidelines to direct development of specific coding relationships or edits;
b) a more detailed reimbursement methodology than the scope of this policy is intended; e.g. 26, TC, AA, QK; or
c) contractual or benefit coverage implications, e.g., 33